Postdeployment reintegration attitude of injured Dutch service members: a longitudinal study.

OBJECTIVE: After deployment, service members can experience difficulties reintegrating. Sustaining injuries on the battlefield can disrupt the reintegration period. The first aim was to follow-up the reintegration attitude towards family, work and on a personal level after deployment in Dutch battlefield casualties (BCs). The second was to compare their postdeployment reintegration attitude with that of healthy controls. METHODS: A questionnaire concerning reintegration attitude, the Postdeployment Reintegration Scale (PDRS), was provided to all service members who received rehabilitation after sustaining injuries in Op TASK FORCE URUZGAN. The questionnaire was administered in 27 BCs at a median of 2 years post incident and 5.5 years post incident. At 5.5 years post incident, the PDRS of the BCs was compared with a control group consisting of service members from the same combat units. RESULTS: A significant difference was found for the BCs with an increased negative personal attitude (p=0.02) and a decreased negative attitude towards work (p=0.02) at 5.5 years compared with 2 years post incident. No differences in postdeployment reintegration attitude was observed between the BCs and controls at 5.5 years post incident. CONCLUSIONS: The results showed that for the BCs the personal attitude becomes more negative in time. However, the negative attitude towards work decreases in time after deployment. Particular attention should be paid to traumatic stress and aftercare.

Identifying prognostic factors to determine the level of recovery in servicemembers with chronic low back pain: A prospective cohort study.

OBJECTIVE: The main objective of this study was to identify general and military-related factors that are associated with the level of recovery in Dutch service members with chronic low back pain (CLBP) who followed a rehabilitation program. MATERIAL AND METHOD: One hundred five consecutive service members with CLBP were included in this study. The level of disability, was used to distinguish a recovered and non-recovered group. Level of pain and self-perceived recovery were used as secondary outcome measurements. Differences were evaluated within and between the groups using the Student's t-test Bivariate logistic regression analyses were used for identifying the prognostic factors related to various outcomes of recoveryRESULTS: After following the rehabilitation program, 64.8% of the service members recovered from CLBP. The recovered group, demonstrated significant effect sizes in disability and in pain The non-recovered group showed on disability a non-significant effect and in pain a significant effect. The self-perceived recovery in the recovered group was "much improved" and the non-recovered group "slightly improved". The results of the bivariate regression analyses showed no significant independent prognostic factors related to recovery. CONCLUSIONS: In this study, no significant independent prognostic factors could be identified that were associated to the various outcomes of recovery in service members with CLBP who followed a rehabilitation program.

Long-term participation of Dutch service members with combat-related injury.

BACKGROUND: After deployment service members need to adapt to civilian life and return to participation in family, vocational and community life. AIMS: To assess the level of activity and participation of service members with combat-related injury after their rehabilitation intervention and to measure the effect of injury severity, adaptive coping, number of deployments and traumatic stress. METHODS: The physical functioning scale of the 36-Item Short Form Health Survey (SF-36 PF), the Assessment of Life Habits short version (LIFE-H), the Impact of Event Scale (IES-R) and the Cognitive Emotion Regulation Questionnaire (CERQ) were administered to service members who sustained combat-related injury. The Injury Severity Score (ISS) was calculated, and the number of deployments was noted. Correlations were calculated between the LIFE-H and ISS, IES-R, number of deployments and adaptive coping and between the SF-PF and ISS, IES-R, number of deployments and adaptive coping. RESULTS: The response rate was 55% (32 service members). A moderate correlation was found between LIFE-H and IES (r = -0.49) and a very weak correlation was found between LIFE-H and injury severity (r = 0.31). No correlation was found between SF-36 PF and ISS, IES, number of deployments or CERQ and between LIFE-H and number of deployments or CERQ. CONCLUSIONS: A moderate correlation was found between level of participation and traumatic stress in service members with combat-related injury in a 5-year follow-up. Therefore, it is advisable to screen for traumatic stress symptoms and monitor these symptoms during the rehabilitation intervention.

Dynamic alignment using external socket reaction moments in trans-tibial amputees.

BACKGROUND: Prosthetic alignment is used to optimize prosthetic functioning and comfort. Spatio-temporal and kinematic gait parameters are generally observed to guide this process. However, they have been shown to be influenced by compensations, which reduces their sensitivity to changes in alignment. Alternatively, the use of moments working at the base of the prosthetic socket, external socket reaction moments (ESRM), has been proposed to quantify prosthetic alignment. RESEARCH QUESTION: To investigate if a predetermined kinetic alignment criterion, 0Nm averaged over the stance phase, can be used to fine-tune prosthetic alignment. METHODS: 10 transtibial amputees were included in this intervention study. Firstly, their prostheses were aligned using conventional alignment procedures. Kinetic parameters and Socket Comfort Score (SCS) were measured in this initial alignment (IA) condition. Subsequently, the coronal plane ESRM during gait was presented to the prosthetist in real time using a Gait Real-time Analysis Interactive Lab. The prosthetist iteratively adapted the prosthetic alignment towards a predetermined average ESRM during the stance phase of 0 Nm. At the Final Alignment (FA), kinetic parameters and SCS were measured again and a paired sample t-test was performed to compare ESRMs and SCSs between alignments. RESULTS: A significant (p < 0.001) change was found in the absolute coronal plane ESRM (mean ± SD) from IA (|0.104| ± 0.058 Nm/kg) to FA (|0.012| ± 0.015 Nm/kg). In addition a significant (p < 0.001) change of the external coronal adduction knee moments was observed from IA (-0,127 ± 0.079 Nm/kg) to FA (-0.055 ± 0.089 Nm/kg), however this change was more variable among participants. On average, no significant (p = 0.37) change in the SCS was observed. SIGNIFICANCE: While this study shows the potential of quantifying and guiding alignment with the assistance of kinetic criteria, it also suggests that a sole reliance on the ESRM as a single alignment criterion might be too simple.

Combat-related foot injuries: impact on gait and functional outcome.

INTRODUCTION: Prior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis. METHOD: In nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire. RESULTS: Significant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59). CONCLUSIONS: This study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler's angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler's angle and physical performance. CLINICAL TRIAL: The Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).

The diagnostic value of three sacroiliac joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging.

OBJECTIVES: The aim of the current study was to investigate the diagnostic value of three sacroiliac (SI) joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging (MRI) and stratified by gender. METHOD: Patients without clinical signs of nerve root compression were selected from a cohort of patients with persistent low back pain referred to an outpatient spine clinic. Data from Gaenslen's test, the thigh thrust test, and the long dorsal sacroilia ligament test and sacroiliitis identified by MRI were analysed. RESULTS: The median age of the 454 included patients was 33 (range 18-40) years and 241 (53%) were women. The prevalence of SI joints with sacroiliitis was 5%. In the whole study group, only the thigh trust test was associated with sacroiliitis, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.58 [95% confidence interval (CI) 0.51-0.65], sensitivity 31% (95% CI 18-47), and specificity 85% (95% CI 82-87). In men, sacroiliitis was associated with all the SI joint tests assessed and multi-test regimens, with the greatest AUC found for at least one positive out of three tests [AUC 0.68 (95% CI 0.56-0.80), sensitivity 56% (95% CI 31-79), and specificity 81% (95% CI 77-85)]. In women, no significant associations were observed between the SI joint tests and sacroiliitis. CONCLUSIONS: Only in men were the SI joint tests found to be associated with sacroiliitis identified by MRI. Although, the diagnostic value was relatively low, the results indicate that the use of SI joint tests for sacroiliitis may be optimized by gender-separate analyses.

The inclination for conscious motor control after stroke: validating the Movement-Specific Reinvestment Scale for use in inpatient stroke patients.

PURPOSE: Stroke survivors are inclined to consciously control their movements, a phenomenon termed "reinvestment". Preliminary evidence suggests reinvestment to impair patients' motor recovery. To investigate this hypothesis, an instrument is needed that can reliably assess reinvestment post-stroke. Therefore, this study aimed to validate the Movement-Specific Reinvestment Scale (MSRS) within inpatient stroke patients. METHOD: One-hundred inpatient stroke patients (<1 year post-stroke) and 100 healthy peers completed the MSRS, which was translated to Dutch for the study purpose. To assess structural validity, confirmatory factor analysis determined whether the scale measures two latent constructs, as previously reported in healthy adults. Construct validity was determined by testing whether patients had higher reinvestment than controls. Reliability analyses entailed assessment of retest reliability (ICC), internal consistency (Cronbach's alpha), and minimal detectable change. RESULTS: Both structural and construct validity of the MSRS were supported. Retest reliability and internal consistency indices were acceptable to good. The minimal detectable change was adequate on group level, but considerable on individual level. CONCLUSIONS: The MSRS is a valid and reliable tool and suitable to assess the relationship between reinvestment and motor recovery in the first months post-stroke. Eventually, this may help therapists to individualize motor learning interventions based on patients' reinvestment preferences. IMPLICATIONS FOR REHABILITATION: This study showed that the Movement-Specific Reinvestment Scale (MSRS) is a valid and reliable tool to objectify stroke patients' inclination for conscious motor control. The MSRS may be used to identify stroke patients who are strongly inclined to consciously control their movements, as this disposition may hinder their motor recovery. Eventually, the MSRS may enable clinicians to tailor motor learning interventions to stroke patients' motor control preferences.

Clinical tests of the sacroiliac joint.

In the literature many tests are described which are designed to provoke pain or detect joint mobility in the sacroiliac joint (SIJ). However, in part 1 of this review, the authors stated that there is little evidence of reliability of these tests. In this article, the authors describe the methodological review of 11 studies, which have dealt with the validity of SIJ tests. The methodological quality of the studies was tested by using a list of criteria that consisted of three categories: 1) study population, 2) test procedure and 3) test results. A weighting for each criterion was developed. The methodological score for the studies was, in general, disappointing and looked promising for only two out of 11 studies (58 and 64 points). Four authors drew conclusions of positive validity from the tests they studied but other authors did not confirm these results. The conclusion of this methodological review is that there is no evidence to support the inclusion of mobility and pain provocation tests for the SIJ in clinical practice. Three major problems have been identified in validating SIJ dysfunction tests. Firstly, poor reliability of SIJ dysfunction tests exists, which may be improved by multiple test scores as postulated in part 1 of this review. Secondly, the methodological quality of validity studies needs to be developed to a much higher level with special consideration paid to sensitivity, specificity, confidence intervals and likelihood ratio values. And finally, there is a need for the proper use of a gold standard in assessing the validity of SIJ tests.

Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.

In the literature concerning the sacroiliac joint (SIJ) there are numerous specific tests used to detect joint mobility or pain provocation. In this article the authors have reviewed 11 studies which investigated the reliability of these tests. The methodological quality of the studies was tested by a list of criteria developed by the authors. This list consisted of three categories: (1) study population, (2) test procedures and (3) test results. To each criterion a weighting was attached. The methodological score for nine out of the 11 studies was found to be acceptable. The results of this review, however, could not demonstrate reliable outcomes and therefore no evidence on which to base acceptance of mobility tests of the SIJ into daily clinical practice. There are no indications that 'upgrading' of methodological quality would have improved the final conclusions. With respect to pain provocation tests, the findings did not show the same trend. Two studies demonstrated reliable results using the Gaenslen test and the Thigh thrust test. One study showed acceptable reliability for five other pain provocation tests; however, since other authors have described contradictory results, there is a necessity for further research in this area with an emphasis on multiple test scores and pain provocation tests of the SIJ.

Intraexaminer and interexaminer reliability of the Gillet test.

OBJECTIVES: The purpose of this study was to determine the intraexaminer and interexaminer reliability of the Gillet test. STUDY DESIGN: In a test-retest study the incidence of asymmetric or symmetric sacroiliac joint motion was investigated with the Gillet test. METHODS: Forty-one male subjects volunteered for this study (mean age, 23 +/- 2.24 years). Thirty-eight subjects were examined in the first test procedure, and at least 4 days later 37 subjects were examined again. The subjects were subdivided into symptomatic and asymptomatic groups on the basis of certain criteria. RESULTS: To obtain the intraexaminer and interexaminer reliability values, Cohen's kappa, the percentage agreement, bias-adjusted kappa, and prevalence-adjusted bias-adjusted kappa were used. The mean Cohen's kappa did not exceed the value of 0.081. Only the percentage agreement of the symptomatic group did exceed the minimum level of 80%. When kappa was positive, the prevalence-adjusted bias-adjusted kappa was markedly higher than kappa; when kappa was negative, the prevalence-adjusted bias-adjusted kappa was only slightly higher than kappa. Only small differences were found between kappa and bias-adjusted kappa. CONCLUSION: The Gillet test, as performed in this study, does not appear to be reliable.

Transchondral Fractures of the Talus on an lnversion Injury of the Ankle: A Frequently Overlooked Diagnosis.

Twenty-one cases of transchondral fractures of the ankle, seen between 1980 and 1984, were studied. Twenty were available for follow-up. The average follow-up period was 23.5 months. In all cases but one the diagnosis was delayed. The diagnosis stated by clinical signs in medial transchondral fractures seems to be pathognomic: localized tenderness on the posterior medial side of the talus, pain increasing on exertion, and provocation of pain on passive plantar flexion. J Orthop Sports Phys Ther 1987;8(7):362-367.

Case Study: Isolated Anterior lnterosseous Nerve Paralysis: The - Kiloh-Nevin Syndrome.

A new case of isolated paralysis of the anterior interosseous nerve of a 24-year-old man is described. It is thought that this was caused by a fall on the left arm. This paralysis has a typical clinical picture with a characteristic disturbance of the pinch grip. The patient recovered spontaneously. A review of the findings previously reported in the literature is presented. J Orthop Sports Phy Ther 1984;6(3):178-180.